Provider Demographics
NPI:1861823890
Name:RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA
Entity Type:Organization
Organization Name:RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA
Other - Org Name:UVA-CENTRA FARMVILLE DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-243-9308
Mailing Address - Street 1:PO BOX 800778
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0778
Mailing Address - Country:US
Mailing Address - Phone:434-466-5008
Mailing Address - Fax:
Practice Address - Street 1:937 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2211
Practice Address - Country:US
Practice Address - Phone:434-390-1592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECTOR & VISITORS OF THE UNIVERSITY OF VIRGINIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-02
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA493515Medicare Oscar/Certification